Hydroxyamphetamine and Buprenorphine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buprenorphine
Hydroxyamphetamine
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Taking these two together may raise your risk of something called serotonin syndrome. Both buprenorphine (a pain and addiction medicine) and hydroxyamphetamine (a stimulant-type drug) can raise levels of serotonin, a brain chemical. When they stack up, the level can climb too high.
Signs to watch for include feeling agitated or confused, a fast heartbeat, sweating, shivering, shaking, or muscle twitching. This is mostly a theoretical concern, meaning it is based on how the drugs work rather than lots of real-world reports. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, and get help right away if you feel these symptoms.
Effect: Additive serotonergic activity may increase the risk of serotonin syndrome. Amphetamine exposure and cardiovascular effects may also be potentiated.
- Mechanism: Pharmacodynamic (additive serotonergic effect); both agents influence serotonergic neurotransmission.
- Direction: Increased serotonergic tone (increases risk, not a PK inactivation). Neither agent is metabolically activated here.
- Evidence/Severity: Theoretical, rated major. Onset unspecified.
- Management: If coadministration is required, initiate at lower doses and monitor closely, especially at initiation and dose titration. Watch for autonomic instability, neuromuscular abnormalities, and mental status changes. Discontinue both agents if serotonin syndrome is suspected.
What happens
An increased risk of serotonin syndrome
Interaction Deep Dive
When an amphetamine is given together with another serotonergic agent, serotonin syndrome can develop, since each of these drugs acts on the serotonergic neurotransmitter system12. On top of this, prolonged elevations in brain d-amphetamine levels may occur, and cardiovascular effects have the potential to be amplified1. Should combined therapy with an amphetamine and such an agent be clinically necessary, begin with reduced doses and observe patients closely, particularly when starting treatment and when adjusting the dose. If serotonin syndrome is suspected, stop both medications32.
Why it happens (mechanism)
Additive serotonergic effects
How to manage this interaction
The good news is your care team can manage this. If both drugs are needed, they will typically:
- Start at lower doses and adjust and individualize the dose for you
- Monitor you more closely, especially when starting or changing a dose
What you should do: Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Tell your pharmacist and doctor that you take both. Seek help right away if you notice agitation, confusion, a racing heart, sweating, shivering, tremor, or muscle twitching, since both drugs may need to be stopped if serotonin syndrome is suspected.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Hydroxyamphetamine and Buprenorphine together?
Combining buprenorphine and hydroxyamphetamine may raise the risk of serotonin syndrome. It is a theoretical concern, but if you take both, use them only as prescribed, watch for warning signs, and get urgent care if symptoms appear. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Hydroxyamphetamine and Buprenorphine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Hydroxyamphetamine and Buprenorphine interaction managed?
The good news is your care team can manage this. If both drugs are needed, they will typically: Start at lower doses and adjust and individualize the dose for you Monitor you more closely, especially when starting or changing a dose What you should do: Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Tell your pharmacist and doctor that you take both. Seek help ri… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Hydroxyamphetamine or Buprenorphine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: VYVANSE(R) oral capsules, oral chewable tablets, lisdexamfetamine dimesylate oral capsules, oral chewable tablets. Shire US Inc (per DailyMed), Lexington, MA, 2018. DailyMed
- Product Information: FETZIMA(R) oral extended-release capsules, levomilnacipran oral extended-release capsules. AbbVie Inc (per FDA), North Chicago, IL, 2023. DailyMed
- Product Information: ADDERALL(R) oral tablets, dextroamphetamine saccharate amphetamine aspartate dextroamphetamine sulfate amphetamine sulfate oral tablets. Teva Select Brands (per FDA), Horsham, PA, 2017. DailyMed
Keep reading about Buprenorphine
Keep reading about Hydroxyamphetamine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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